Main menu

Patients’ Bill of Rights Remains on Congressional Agenda

Patients’ Bill of Rights Remains on Congressional Agenda

May 01, 1999

FORT LAUDERDALE, FlaBefore talking about the various
patients bill of rights legislation before the US
Congress, Harry D. Holmes, PhD, played the theme from the movie Back
to the Future. Thats what it seems like in managed
care reform, since all of these bills were filed last year and here
they are again, both in the House and the Senate.

In his presentation at the Fourth Annual Conference of the National
Comprehensive Cancer Network (NCCN), Dr. Holmes, associate vice
president of government relations, M.D. Anderson Cancer Center,
outlined the major issues covered in the proposed legislation.

First, all of the bills would provide access to emergency care,
either in or out of the managed care network, without
preauthorization. Most of the proposed bills use the prudent
layperson standard for defining an emergency. In other
words, you dont need a physicians decision or evaluation;
if a prudent layperson believes its an emergency, then its
an emergency, he said, adding that severe pain is included in
this definition.

Most of the proposed bills have some clinical trials coverage.
Some of them require authorization, some dont; some allow
for an appeal to an external panel if internal authorization is
denied, he said.

Some of the proposed bills have patient confidentiality sections,
regarding not only the patients medical record but also genetic
testing. The controversy here is that some members of Congress think
that there should be no access to a patients medical records, a
proposal opposed by many clinical researchers.

Dr. Holmes noted that most of the bills would improve the
patients right to internal and external appeals when coverage
is denied. There would be a specific time frame for coverage
decisions, and the time frame is short in the case of urgent or
emergency care, he said.

In most of the bills, cancer patients would fall under the emergency
care provision for an expedited appeal process, since expedited
refers to situations in which a delay of treatment would seriously
jeopardize the patients health. Most of the bills use 72
hours for the conclusion of that expedited appeal. Thats rocket
speed if youre familiar with the standard 30 days with a 45-day
review after that, he said.

Major differences among the various bills will require compromise for
passage. For example, one stumbling block is ERISA (Employment
Retirement Income Security Act), passed in 1974, which took away the
ability of the states to regulate certain types of plans, including
most self-insured plans. Some of the bills seek to restore this power
to the states.

Another major difference concerns a cap on liability. The
Democrats do not want to see a cap on liability; Republicans, for the
most part, favor a cap on liability, he said. A possible
compromise would be to put a cap on damages by plaintiffs
attorneys. Other controversial provisions in some bills that Dr.
Holmes predicts will eventually be dropped or modified include the
creation of insurance purchasing co-ops and the expansion of medical
savings accounts.

Finally, enforcement of most of the bills is by civil penalties.
The civil penalties are capped, he said, but these
bills do have some teeth in them.

Dr. Holmes best guess is that a centrist bipartisan
bill will pass. Theres only a six-vote margin in the
House so it has to be bipartisan. The health care leaders in the
Senate are centrists, and the Speaker of the House is a compromiser,
so I think the chances are good that well see a bill this year,
if we can work past the liability issues.

Your name

E-mail

The content of this field is kept private and will not be shown publicly.